Provider Demographics
NPI:1275853111
Name:PROFESSIONAL CHRISTIAN COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL CHRISTIAN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EGBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-752-7000
Mailing Address - Street 1:110 E REYNOLDS ST
Mailing Address - Street 2:SUITE 807
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3361
Mailing Address - Country:US
Mailing Address - Phone:813-752-7000
Mailing Address - Fax:813-759-6871
Practice Address - Street 1:110 E REYNOLDS ST
Practice Address - Street 2:SUITE 807
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3361
Practice Address - Country:US
Practice Address - Phone:813-752-7000
Practice Address - Fax:813-759-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8757251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health